Blindness

INTRODUCTION

Definition : WHO defines blindness as visual acuity of less than 3/60 (snellen) or it equivalent Inability to count fingers in day light at a distance of 3 meters (To indicate less than 3/60 or its equivalent

I.e.

There are four levels of visual function, according to the ICD -10 (Update and Revision 2006) Normal vision Moderate visual impairment Severe visual impairment Blindness

Economic Blind = Work vision Vision <6/18 3/60 in better eye Social Blind = Walk vision <3/60 in better eye Total blindness

Categories of Visual Impairments Low Vision Blindness 1

WHO Categories of impairment

Less than 6/18

Visual Acuity Equal to or more than 6/60

2 3

6/60 3/60 (Finger counting at 3 metres) 1/60 (finger counting at 1 metre) No light perception

3/60 1/60 (finger counting at 1 metre) Light perception

Extent of the problem:

Globally There are 1.4 million blind children
1 million of whom live in Asia and 300 000 in Africa.

Prevalence ranges from 0.3/1000 to 1.5/1000 Presently there are about 180 million visually disabled, due to low vision, including 45 million blind. This number is likely to be doubled by 2020
(http://www.vision2020.org/main.cfm?type=WIB

 India:

7 million blinds of 45 millions About 80% of the blinds in India are blind because of either preventable or curable cause. Prevalence of blindness 1.1 in general population, and the high pervalence in the children between age groups of 10 to 14 years ( 6 to 7%) and elderly (8.5%)

High prevalence of Blindness in India.

Poor nutritional status Poor access to eye care facilities Inadequate availability of trained health personals & inadequate utilization of available ophthalmic surgeons Adverse environmental and domestic unhygienic conditions. Lack of community awareness & poor health seeking behavior Prev. Of myths &misconceptions about surgeries. Size of population Life expectancy

Causes of Blindness
Sr. No 1 2 3 4 5 6 Cause Cataract Percentage 62.6

Refractive errors 19.7 Glaucoma 5.8 Post. Seg. Pathology 4.7 Corneal Opacities Other causes 0.9 6.2

Epidemiological factors
Age Sex Malnutrition Occupation Social class Social Factors

Changing concept in eye care

Primary eye care Epidemiological approach Team concept Establishment of national program

Goal : reduce blindness to 0.3 % by 2000

Prevention of Blindness
1. Initial Assessment Survey : (1) To Assess the magnitude of Problem (2) Find out causes of blindness 2. Methods of Intervention (a) Primary eye care at village level PHC (b) Secondary Eye Care District Hospital Mobile eye clinics (c) Tertiary Care Medical Colleges - Institutions - Capital level hospitals - National level hospitals

Specific Programmes
5. 6.

(i) Trachoma Control Programme-1963 (ii) (iii) (iv) School eye health ServicesVit A prophylaxis Occupational eye health services

4 Long Term measures Evaluation National Programme for Control of blindness

National Program for control of Blindness

National Programme for Control of Blindness was launched in the year 1976 as a 100% centrally sponsored scheme with the goal to reduce the prevalence of blindness from 1.4% to 0.3%. India was the first country to launch the National Programme for Control of Blindness

Objectives

The objectives of the programme are To reduce the backlog of blindness through identification and treatment of blind. To develop Eye Care facilities in every district. To develop human resources for providing Eye Care Services.

To improve quality of service delivery.

To secure participation of Voluntary Organizations in eye care.

Organisation structure (administration)

Central Distric
Ophtalmology section , DGHS, MOHFW,ND

State opthalmic cell,DGHS, state health societies

state

DBCS

Service delivery and referal centre

Tertiary
Regional institute of othalmology and centre of excellence in eye care medical college

Secondary
District hospital NGO eye hospital

Primary
Subdistrict level hosp Mobile opthalmic unit Upgrade PHc Link worker

School Screening program

Under NPCB, all children bet 10-14 years will be screened for Refractive erroes by trained teachers V/A <6/9, with any eye will be sent to ophthalmic assistant, in CHC, who after evaluation, will provide free spectacles to students if required. ( through opticians contracted through NPCB)

Collection and utilization of donated eyes

Hospital retrival programme Eye donation fortnite 25 aug to 8 sept

Community health education

Aided by : world bank, Danish, WHO

Vision 2020

Vision 2020: the right to sight: Global initiative to avoidable blindness If no measures taken, the no of blinds would be expected to double by 2020AD, (as of 1995), WHO along with its other global partners launched Vision 2020 initiative in 1995.

It has 3 essential elements as Setting up strategies and targets fir disease control Planning human resource needs and development Adressing infrastrcture needs and deveopment. Under initiative, complete elimination of avoidable blindness by 2020

The diseases identified for global elimination includes Cataract blindness Trachoma blindness and transmission Onchocerciasis Avoidable causes of childhood blindness Refractive errors

INFRASTRUCTURE BY 2020 UNDER NPCB

20
200 TC Centre Of Excellence: 1 for 5 crores Training Centre: 1 for 50 Lakhs Service Centre: 1 for 5 Lakhs
Vision Centre: 1 for 50,000

2000 SC

20000 VC

Central of excellence Professional leadership Strategy devlp CME Laying std and quality assurance Research

Training centre Tertiary eye care including retinal sugery, corneal grafting ,glaucoma Training and CME

 Service

centre
Cataract surgery Other common eye surgery Facilities for refraction Referral service

Vision centre Refraction and prescription of glasses Primary eye care School eye screening programme Screening and referal service